Strange Encounters

A 7-year-old girl was brought to the emergency department because of moderate pain on swallowing and mild upper abdominal discomfort. A few hours earlier, she had been given a piggy bank in order to save money for a family trip planned for the next day. On shaking the piggy bank upside down above her head, a few coins fell out. The child admitted to swallowing a coin. Physical examination findings were unremarkable. A plain abdominal radiograph showed what appeared to be 1 coin in the stomach (A)

These extensive, smooth, irregular masses of pigmented tissue on the earlobes of a 28-year-old woman are keloids. The patient had her ears pierced at age 6 years; the masses began to develop when she was about 9 to 10 years old. The right earlobe mass arose first and is larger. She had one other keloid of 1 cm on her chest that had developed after a scratch. She denied any other skin lacerations or incisions.

A 68-year-old woman was hospitalized because of confusion and agitation of sudden onset. Her history included dementia and multiple infarcts of both cerebellar hemispheres, bilateral basal ganglia, bilateral parietal lobes, and the right occipital lobe.

A 53-year-old man with a 30-year history of heavy injection drug use (10 to 15 bags of heroin per day) was hospitalized with fever (temperature, 39.2°C [102.5°F]) and chills of 2 days' duration. Infective endocarditis was diagnosed based on the results of 3 sets of blood cultures, which were positive for methicillin-sensitive Staphylococcus aureus.

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